June 11–15, 2010
NIDA International Forum Focuses on Research To Inform Drug Policy and Public Health
Plenary session speakers at the 15th National Institute on Drug Abuse (NIDA) International Forum explored the ways drug abuse researchers and policymakers can develop evidence-based drug policies that include public health as a priority. Dr. A. Thomas McLellan, White House Office of National Drug Control Policy Deputy Director, offered his perspective as a leading drug abuse researcher turned policymaker, describing the relatively new U.S. perspective that demand drives the production and trafficking of illicit drugs. Dr. McLellan discussed how that insight shaped the focus on community-based prevention interventions and integration of drug treatment into primary health care settings in the U.S. National Drug Control Strategy, which was released in May 2010. Dr. McLellan added that the U.S. posture on drug abuse was similar to the country’s response to the global financial crisis: the problem of drug abuse cannot be solved by a single nation, and the United States needs strong and committed partners to succeed in reducing addiction.
NIDA International Program Director Dr. Steven W. Gust chaired the meeting, which was held June 11–15, 2010, in Scottsdale, Arizona, as a satellite to the Annual Scientific Meeting of the College on Problems of Drug Dependence (CPDD). More than 240 participants from 49 countries participated in the plenary session, workshops, and networking activities. A joint CPDD/NIDA International Forum poster session featured presentations by 140 U.S. and international researchers as well as representatives from 11 NIDA components. The NIDA International Program also supported a second CPDD satellite, the International Women’s and Children’s Health and Gender Conference.
Dr. Gust reviewed NIDA initiatives to support research that informs and implements policy set through the National Drug Control Strategy and to translate research into practice. He highlighted the International Program initiatives to fund international collaborative research, such as the international collaborative grants for research into drug-related HIV/AIDS and the U.S.–Netherlands binational research awards; train drug abuse researchers through fellowships, online training courses, and a new writing mentorship program with the International Society of Addiction Journal Editors; and foster information exchange through meetings, virtual working groups, and a forthcoming journal supplement.
Dr. McLellan also discussed the principles used to identify demand reduction priorities established by the National Drug Control Strategy, including identifying evidence-based, practical interventions that could be supported by the political will, delivered within communities, and supported through Federal investment in infrastructure. He described reviews of prevention research that found comprehensive, consistent, repetitive, and age-appropriate interventions not only prevented addiction but also reduced other risk behaviors such as depression, bullying, dropping out of school, and teen pregnancy. Dr. McLellan added that research evaluating primary care screening for substance abuse demonstrated that two or three questions could help physicians accurately identify harmful substance abuse, and that a related 5- to 10-minute intervention saved $8 million to $10 million dollars in subsequent health care costs. He summarized behavioral and pharmacological treatments proven effective in treating addiction. Based on this evidence, the National Drug Control Strategy set five priorities for demand reduction: (1) build a national system of prevention-prepared communities; (2) train primary care providers to intervene early when patients exhibit signs of emerging abuse; (3) improve and integrate addiction treatment into mainstream health care, especially the Federal systems operated by the Veterans’ Affairs, Indian Health Service, and Health Resources and Services Administration; (4) promote smart, safe management of drug-related offenders; and (5) establish performance-oriented monitoring systems.
Awards of Excellence
The NIDA International Program presented its 2010 Awards of Excellence to honor mentors, researchers, and binational collaborative teams whose efforts support the International Program mission, including the following: Excellence in Mentoring: Dr. Walter Ling, University of California Los Angeles; Excellence in International Leadership: Dr. Evgeny Krupitsky, Pavlov Medical University and Bekhterev Research Psychoneurological Institute, Russia; and Excellence in International Collaborative Research: Dr. Thomas F. Babor, University of Connecticut, and Dr. Robin Room, University of Melbourne and Turning Point Alcohol and Drug Centre, Australia.
Drug Policy and the Public Good
The NIDA International Forum plenary session on drug policy and the public good was chaired by Dr. Thomas F. Babor, University of Connecticut, who described a multinational, interdisciplinary review of evidence-based drug policy designed to make scientific evidence relevant to policymakers and build the case for including public health as a priority in all drug policies.
Dr. John Strang, United Kingdom National Addiction Centre, reviewed treatment systems and treatment policy, highlighting the false dichotomies that frequently shape discussions about treatment systems, such as law enforcement versus treatment; abstinence versus harm reduction; and drug users versus mainstream society. He cited the French and Swiss introduction of large-scale opiate substitution services and U.S. drug courts as service system changes that made a difference in addressing drug abuse. Dr. Strang concluded that the location of drug treatment services impacts access, quality, coordination, cost-effectiveness, and stigma associated with them.
Dr. Peter Reuter, University of Maryland, discussed the national drug control policies in seven nations, stressing that drug problems and policies are influenced by sociological, political, economic, historical, and ideological factors that preclude a single, multinational drug policy that would be effective in every country. Dr. Reuter concluded that policy research agendas will differ across nations, with trafficking and producing countries adopting a different focus than consuming nations, and that policy recommendations must be situated within the specific context of national cultures and drug use patterns.
Dr. Robin Room, University of Melbourne and Turning Point Alcohol and Drug Centre, described the interaction among scientific advances, changing expectations of civil society, and evolving political considerations to highlight the issues facing the historical narcotics control system. Although Dr. Room said amending the current treaties was unlikely, he identified options for an individual country, such as denouncing the current treaty and then reacceding to it with reservations or nullifying part or all of the treaty with national legislation. He also described how a group of countries could adopt a new convention that would take precedence in case of conflict, such as the draft Framework Convention on Cannabis Control that kept the strict controls on the international market from the 1961 Convention but modified provisions for internal market control to follow the Framework Convention on Tobacco Control.
Dr. Babor presented 10 overarching conclusions about drug abuse and drug policies that the multinational team reached:
- There is no single drug problem within or across societies; neither is there a magic bullet that will solve “the” drug problem.
- Many policies that affect drug problems are not considered drug policy, and many specific drug policies have large effects outside the drug domain.
- Efforts by wealthy countries to curtail cultivation of drug-producing plants in poor countries have not reduced aggregate drug supply or drug use, and probably never will.
- Once drugs are made illegal, there is a point beyond which increases in enforcement and incarceration yield little added benefit.
- Substantial investments in evidence-based services for opiate-dependent individuals usually reduce drug-related problems.
- School, family, and community prevention programs have a collectively modest impact, the value of which will be appraised differently by different stakeholders.
- The drug policy debate is dominated in many countries by false dichotomies that can mislead policymakers about the range of legitimate options and their expected impacts.
- Perverse impacts of drug policy are prevalent.
- The legal pharmaceutical system can affect the shape of a country’s prescription drug problem and its range of available drug policy options.
- There is virtually no scientific research to guide the improvement of supply control and law enforcement efforts.
Concurrent breakout sessions focused on developing a consensus statement on treatment guidelines for pregnant women, co-chaired by Dr. Hendrée Jones, RTI International, and Dr. Vladimir Poznyak, World Health Organization; developing research projects to inform policy, chaired by Dr. Alison Ritter, National Drug and Alcohol Research Centre; cultural adaptations of family-based interventions to strengthen families and prevent substance abuse, chaired by Dr. Karol L. Kumpfer, University of Utah; and drugged driving, chaired by Dr. J. Michael Walsh, The Walsh Group.
The alumni meeting of the NIDA International fellowship programs was co-chaired by Ms. Dale Weiss, NIDA International Program, and Dr. J. Randy Koch, Virginia Commonwealth University. Former NIDA Humphrey Fellow Mr. Nguyen Cuu Duc, Vietnam, presented the best practices in drug demand reduction in the Asia-Pacific Region, which he oversees as director of the multinational Colombo Plan Drug Advisory Programme. Ms. Mayra Hynes-Dowell, Inter-American Drug Abuse Control Commission (CICAD), discussed the process of building an Inter-American drug research system and the system’s impact on research and policy in the region.